The Baby Business: Iran’s “Fertility Brokers”

Like all of the world’s capitals, Tehran’s vast cityscape is cluttered with billboards and posters encouraging people to buy refrigerators, furniture and cars. In a country where selling organs for profit is legal, there are even signs advertising kidneys. And now on the market: embryos and fertilized eggs.

“Highly-paid work for young women,” the signs read, which are predominantly found outside fertility clinics and doctors’ offices. “Donate your eggs or an embryo.” Unlike billboards trying to sell soap and promote mega malls, these adverts are modest and simple, plain, unadorned text stating the services available and who to contact about it. In case there’s any cause for concern—this, after all, is a fairly new kind of advertising on the streets of Tehran—the adverts include reassurances that the enterprise is “supervised by specialist doctors” affiliated with reputable hospitals.

I dial one of the numbers provided on the sign and a woman answers. The moment I say I’ve called in response to an ad, she immediately begins talking over me: “My dear, we work with married women from 24 to 30 years old. You take medication for 10 to 12 days and, after some tests, you can donate your ovum. It’s a simple operation. It takes just a few days of your time. For your work, you will be paid two million tomans”—a little under $800.

Ovum donation involves extracting a woman’s egg, in vitro fertilization using the husband’s sperm, and implanting the fertilized egg into the womb of the woman who is hoping to have a baby.

“If you want to donate an embryo,” the woman says quickly, “you must go through more tests. It pays twice as much.”

“I know you have to think about it and get advice,” she says, when she’s finished telling me everything I need to know. “Call me when you decide.” As I say goodbye, she adds: “I promise, you cannot find better work. It's simple, it pays—and it’s a good deed too.”

Cash up Front—But the Match Must be Right

A few hours later, I call the same number, this time pretending to be a customer who wants a fertilized egg. A man answers and tells me, “If you want one immediately, I have two ready. You pay up front in cash, 3.5 million toman (about $1400).”  Before I can answer, he says, “But it will only work if the physical characteristics match yours. One is listed here as being 165 centimeters tall with a sun-tanned skin color. The other is 158 centimeters tall with white skin.”

Royan Institute, a leading Iranian biomedical, stem cell and fertility research center, offers similar advice about suitable matches on its website: “It is recommended that the physical characteristics of the person who receives the ovum and that of the person who donates it be compatible. Characteristics such as skin color, color of the eyes and physiognomy are important.”

This is clearly a concern for the women who use these services, if a Google search of “embryo and ovum donation” in Persian is anything to go by. There are a number of forums where women recommend doctors, ovum “dealers” and potential donors to hopeful mothers-to-be. Women also share their worries about the process; some of the main concerns are physical appearance, genes and the medical history of donors.

 “I worry all the time,” writes a woman who is hoping to get an embryo. “What if the baby doesn’t look like me or my husband at all? Please, God, let the donor resemble me!”

There are thousands of posts and questions on these forums. One woman writes that she has had to wait two years to receive a fertilized egg from the Royan Fertility Clinic. When people on the site suggest a middleman, she replies, “My husband says they must have a trick under their hats. If finding an egg is so easy, why can’t Royan do it? Perhaps they don’t do enough research, just a few tests. If our baby grows up to become violent and slits our throats in the middle of the night, then what?”

In reply to this sort of comment, many on the forum insist that moral values are acquired rather than inherited. But even the reputable Royan Institute does not dismiss heredity altogether. According to the center’s website, “A psychological evaluation of the donor by a professional is highly recommended.” It’s important, the site says, to “check the family’s history and education, mental health background and the motive for donation, as well as legal records.”

But potential medical and psychological complications are only a small part of what childless couples confront. Islamic scholars have yet to reach a consensus on in vitro fertilization. Some forbid it, some allow it and others believe it can be done only in specific circumstances. With this in mind,  fertility clinics in Iran advise prospective parents to follow the decrees of high-level clerics—leaving it to the individual to decide just which opinion to follow.

The suggestion is that, despite the fact that academics and medical professionals in Iran have welcomed advances in assisted reproductive technologies in infertility, for the average couple, artificial insemination is in many ways taboo, or at least outside of what they consider to be normal. Though this does not necessarily set Iranian women apart from women in other parts of the world undergoing similar treatments, in Iran’s very unique conservative society, where politicians and clerics routinely peddle dictats about how family life should be conducted, the embryo and egg “business” is problematic at best—and fraught with controversy and trauma at worst.

A poster advertising “highly-paid work for young women.” “Donate your embryos and eggs now.”

An Embryo Dealer Talks

After finding the number of one of the “embryo brokers” online, I tell the person who answers the phone that I’d like to ask a few questions for an article I’m writing.  She pauses, and then agrees, but asks for her voice not to be broadcast on radio or television.

“Why are fertility clinics such as Royan always short of female eggs and fetuses when your company seems to find them quite easily?” I ask.  She says her business uses advertising to bring in donors. Part of the advertising strategy is to make a positive case for donation. “A few of my female relatives have done it and they have found that the money is good,” she tells me, adding that when people see that others have gone through the process without any inconvenience or health problems, it becomes an attractive money-making option for them. “ All donors are tested for AIDS, hepatitis and addiction. They must be non-smokers. These are the conditions.”

The woman from the embryo “bank” says that out “of every 10 or 15 people who call two or three agree to donate”. When I ask her how much money she makes from each donation and its sale, she says, ”Please don’t ruin my livelihood.” She then says, “It’s hard work. You must make both parties happy.” She also says she makes concessions if someone comes to her with financial constraints; where possible, she’ll make “adjustments” so that the woman can afford her services. Fees generally range from around one to two million toman ($400-$800). Each case is looked at individually.

The infertility forums devote whole sections to costs, outlining what both fertility clinics and brokers charge. Some women write that money is no object: all they want is a child. Women celebrate the success of their treatment, announcing they’re happily pregnant. Others express their sadness at still not being able to have a baby, despite undergoing treatment. And others chime in, saying they want to donate embryos.

Moral Dilemmas and Legal Implications

I call Dr. Ahmad Ariaee Nejad, head of the parliamentary Commission on Health and Treatment to ask him about Iran’s embryo and egg brokers. “There must be laws governing the donation of ova and embryos and the sale and purchase of them through dealers,” he tells me. “Moral questions are more important than the exchange of large amounts of money. As for donation, if the sincerity, the health and the motives of the parties involved becomes questionable then it would pose a threat to society. Framing laws and enforcing those laws must also take into account the question of middlemen.”

Once a woman agrees to donate, fertility specialists make sure more than one egg is fertilized in vitro so that if one fails there are other chances for success. If a “client” becomes pregnant after implantation, other embryos are frozen in the center, labelled with the name of the couple who underwent fertility treatment. If the couple decides not to use these embryos, whether at the time of the procedure or at some time in the future, they can donate the embryos to others. Judging from the comments on many of the websites that deal with fertility issues, many women currently receiving treatment are confident that if they become pregnant, they’ll donate embryos without expecting any monetary compensation.

These sites also publish comments from women who, having undergone treatment without success, now plan to adopt. For the most part, the comments and suggestions are as you’d expect, but several posts were disturbing, revealing a surprising level of desperation—among women wanting babies as well as those hoping to make money out of this new business. One woman posted a phone number and wrote, “I know a woman who has four daughters and is now pregnant with another. She is ready to donate her daughter. She will give birth in ten days.”

As Dr. Ahmad Ariaee Nejad says, Iran needs clear legislation to address a rapidly growing area of commerce, for both buyers and sellers. But the suggestion that there’s a potential market for full-term fetuses exposes even deeper ruptures in Iranian society. It’s time for Iranian lawmakers to look not only at who and what drives the growing fertility brokerage business, but also at already-existing laws concerning the welfare of a newborn baby. If, as fertility clinics like Royan suggest, Iran’s clerics provide valuable guidance to couples on how to acquire the family life they’ve always dreamed of, perhaps it’s time to have a closer look at the pressures and taboos modern Iranian families face.